Validity of Contrast Enhanced Ultrasonography and Dynamic Contrast Enhanced MR Enterography in the Assessment of Transmural Activity and Fibrosis in Crohn´s Disease

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Background and Aims: Increased small intestinal wall thickness correlates with both inflammatory activity and fibrosis in Crohn's disease (CD). Assessment of perfusion holds promise as an objective marker distinguishing between the two conditions. Our primary aim was to determine if relative bowel wall perfusion measurements correlate with histopathological scores for inflammation or fibrosis in CD.

Methods: Twenty-five patients were investigated prior to elective surgery for small intestinal CD. Unenhanced Ultrasonography (US) and MR Enterography (MRE) were applied to describe bowel wall thickness. Perfusion was assessed with Contrast Enhanced US (CEUS) and Dynamic Contrast Enhanced MRE (DCE-MRE). Histopathology was used as gold standard.

Results: Compared to histopathology, the mean wall thickness was 0.4 mm greater on US (range -0.3 to 1.0, p=0.24) and 1.4 mm greater on MR (0.4 to 2.3, p=0.006). No correlation was found between the severity of inflammation or fibrosis on histopathology and neither DCE-MRE (r=-0.13, p=0.54 for inflammation and r=0.41, p=0.05 for fibrosis) nor CEUS (r=0.16, p=0.45 for inflammation and r=-0.28, p=0.19 for fibrosis). Wall thickness assessed with US was correlated with both histological inflammation (r=0.611, p=0.0012) and fibrosis (r=0.399, p=0.048). The same was not true for MR (r=0.41, p=0.047 for inflammation and r=0.29, p=0.16 for fibrosis).

Conclusions: Bowel wall thickness assessed with US is a valid marker of inflammation in small intestinal CD. However, relative contrast enhancement of US or MRE cannot distinguish between inflammatory activity and fibrosis.

TidsskriftJournal of Crohn's & colitis
Sider (fra-til)48-56
Antal sider9
StatusUdgivet - 2018

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